Medicaid Cut To Disabled Boy

September 8, 2005|By Sallie James Staff Writer

CORAL SPRINGS — For 3 1/2 years, Amy Torchin's severely brain-damaged son has been cared for by a skilled nurse 12 hours a day. Then, 21/2 weeks ago, Medicaid abruptly cut his care without notice, leaving his mother to feed him through a stomach tube and suction his throat.

Although Torchin has managed to get the care temporarily reinstated, she can't believe services for such a medically fragile child were somehow deemed "unnecessary." She also can't believe the state never bothered to tell her it was taking the care away.

"This is my handicapped child! You send someone a letter and explain your position. They never notified me, I never got due process, I never got anything," Torchin said. She discovered 5-year-old Todd's care had been terminated when the local home health care agency that provided his nurse called to say the nurse wasn't coming back.

"My son has rights," Torchin said. "I fought so hard to give my son a life, and now this."

Torchin, 32, has been tending her son at home ever since he nearly drowned in a lake in Coral Springs. The boy can't feed himself, walk or talk, and receives food and medication through a tube in his stomach. So when Todd's nurse quit showing up on Aug. 21, Torchin panicked.

For 10 days she struggled to care for Todd while she tried to get answers from Keystone Peer Review Organization (KePRO South), the private company hired by the state to manage patient care for Medicaid recipients.

She got Todd's nursing care temporarily reinstated on Aug. 31 and is waiting for a hearing. Torchin still doesn't know where or when the hearing will take place or who will hear her case because no one from KePRO has ever called her back.

KePRO's director of Florida operations, Mary Kay Kohut, declined to discuss Torchin's case and refused to explain the hearing process or how it works, saying, "I can't discuss any cases or our process." Kohut referred all questions to the Agency for Health Care Administration in Tallahassee.

Jonathan Burns, a spokesman for the agency, said Torchin's experience is not the norm. "All [Medicaid] participants should have adequate notice before there is some kind of change in their service," he said.

On Aug. 29, eight days after her son's care was terminated, Torchin received official written notice of the change from KePRO. A form letter said Todd's nurse had been cancelled because his care was not "medically necessary." The letter was dated Aug. 25, four days after the nursing care had been cut off.

Anne Swerlick, a Tallahassee attorney who specializes in health law, said any Medicaid recipient who is receiving a service must get advance notice the service is going to be reduced or cut with specific reasons why.

Sallie James can be reached at Sjames@sun-sentinel.com or 954-572-2019.